Impact of Calcified Lesion Complexity on the Success of Percutaneous Coronary Intervention With Upfront High-Speed Rotational Atherectomy or Modified Balloons - A Subgroup-Analysis From the Randomized PREPARE-CALC Trial

Rayyan Hemetsberger, Ralph Toelg, Nader Mankerious, Abdelhakim Allali, Hussain Traboulsi, Dmitriy S. Sulimov, Mohamed El-Mawardy, Robert A. Byrne, Derek R. Robinson, Adnan Kastrati, Mohamed Abdel-Wahab, Gert Richardt

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Background/purpose: In the randomized PREPARE-CALC trial, lesion preparation of calcified lesions with upfront rotational atherectomy (RA) prior to drug-eluting stent (DES) implantation resulted in higher acute success as compared to a provisional modified balloon (MB) strategy. We aimed to investigate the impact of calcified lesion complexity on the treatment effect with either MB or RA. Methods/materials: Two hundred patients were randomized to lesion preparation with either MB or RA. The study population was stratified according to lesion complexity into at least one type-C lesion or into exclusively non-type-C lesions. Endpoints were strategy success, need for bail-out RA, acute lumen gain, and late lumen loss (LLL) at 9 months. Results: In total, 143 patients were graded as type-C (45% patients were allocated to MB), whereas 57 patients were graded as non-type-C (61% patients were allocated to MB). In patients with at least one type-C lesion, strategy success with RA was higher than with MB (97% vs 72%, p < 0.001), but superiority of RA was not observed in patients with non-type-C lesions (100% vs 97%, p = 1.00; pinteraction = 0.001). The need for bail-out RA was higher in patients with type-C lesions (n = 15) as compared with non-type-C lesions (n = 1). Acute lumen gain, LLL, and target lesion revascularization at 9 months were not dependent on lesion complexity and upfront lesion preparation strategy. Conclusions: In patients with calcified non-type-C lesions, the treatment strategy with RA or MB before DES implantation results in comparable success rates, whereas in type-C lesions upfront RA appears to be the superior upfront strategy.

Original languageEnglish
Pages (from-to)26-31
Number of pages6
JournalCardiovascular Revascularization Medicine
Volume33
DOIs
StatePublished - Dec 2021

Keywords

  • Calcified lesion
  • Complex coronary lesion
  • Lesion preparation
  • Type-C lesion

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